Lung cancer is the second most common cancer in the world

Lung cancer is the second most common cancer in the world in terms of incidence and the most common in terms of mortality.

Lung cancer is a malignant tumor that develops in the lung tissue.

In recent years, this cancer has risen slightly in men, while it has risen sharply in women. The smoking epidemic in women began a few decades later than in men, hence the difference.

The main cause of lung cancer is active smoking, which increases the probability of developing this disease up to 30 times. When smoking cessation begins, the likelihood of developing cancer begins to decrease, but even 30 years after smoking cessation, it does not fully equate with the likelihood in non-smokers. Lung cancer is also affected by passive smoking, which means inhaling cigarette smoke when others smoke, and which increases the likelihood of developing lung cancer by 20%. Other causes of lung cancer are exposure to asbestos, radon and heavy metals and their compounds.

The fact that lung cancer is difficult to cure is also due to the fact that it grows without symptoms.Most cancers occur on the periphery of the lungs, where there are no senses, so patients do not cough or feel pain, and cancer cells continue to grow smoothly.

WHAT ARE THE SYMPTOMS? No symptoms point directly to lung cancer, but they can also be symptoms of other diseases. When symptoms appear, it may be too late for successful treatment.The symptoms of lung cancer depend on the progression of the cancer. Early symptoms include: • a new, persistent cough or worsening of a chronic cough, sometimes with bloody sputum, • chest pain, which may be dull or sharp, worsens on inhalation and is caused by inflammation of the sternum over the affected part of the lungs (pleurisy), • shortness of breath, • wheezing if the tumor grows in the airways and obstructs airflow. • altered shape of fingertips and nails (beta fingers), • occasional hoarseness.

Symptoms appear earlier if the tumor is located closer to the central airway, may be as bleeding or as obstruction of the main airways (difficulty breathing). Otherwise, the disease is detected in the early stages most often by chance. For example, when a patient undergoes an X-ray examination, e.g. in occupational medicine, or when, after recovering from pneumonia and respiratory infections, the infiltrate persists in the lungs, or as part of the required examinations before certain procedures.

Treatment in different stages of the disease

In the first and second stages, the patient can be treated with surgery. "Depending on the size of the tumor or the involvement of the first-order lymph nodes, we decide to add chemotherapy. The disease in the third stage is usually so locally widespread that we do not opt ​​for surgical treatment, and most of these patients are treated with combination therapy - a combination of radiation and chemotherapy. In the fourth stage, the disease is already metastatic and is treated systemically. Systemic therapy may involve classical chemotherapy, the second is targeted therapy, and the third systemic therapy is immunotherapy. In the near future, treatment with combinations of these therapies (especially chemotherapy and immunotherapy) will also be possible.

Diagnosis Diagnosis is multidisciplinary and the procedure is led by a pulmonologist. The goals of diagnostic treatment are to determine the prevalence of the disease as soon as possible, to perform tumor verification, and the patient should also be assessed in terms of how capable he is of treatment. So how does it go? Staša Jelerčič: “The first diagnostic examination is an X-ray of the lungs, and a personal doctor decides on it in case of problems. If a tumor is suspected, the patient is referred to a pulmonologist, who performs further diagnostics. These are in-depth scans, first a CT scan of the chest, and in case of a suspected malignant lung tumor, a CT scan of the head and abdomen. These examinations are followed by confirmation of the diagnosis by removal of the diseased tissue, most often by bronchoscopy, followed by examination of the tissue by a pathologist. Namely, we want to define as precisely as possible, including molecularly, what type of tumor it is.

Treatment Once the diagnosis of lung cancer is confirmed, such a patient presents himself at one of the multidisciplinary councils, where experts from various branches of oncology, together with a radiologist and a thoracic surgeon, decide on the type of treatment.

Prior to each treatment, the patient's possible associated diseases, current performance, and problems should be inquired about. "If it is an extended - metastatic disease and the patient is in poor condition or has other reservations about systemic treatment - mostly due to associated diseases - the patient can be treated only symptomatically, ie only with measures to alleviate the patient's problems. Here we are talking about alleviating problems with medications or other local measures or interventionsHowever, if CT scans show that the disease is limited to the chest, the patient is additionally referred for a PET-CT scan, which confirms the limited stage. If the disease is found in the lungs and in the lymph nodes of the interstitium, cure is still possible (this is the third stage) and the patient is treated with a combination of radiation and chemotherapy. According to the new law, maintenance therapy with immunotherapy is already used in such patients in the third stage.

What is immunotherapy? Immunotherapy represents a new breakthrough in the treatment of cancer patients. How It Works? “All cancers are immunogenic in the early stages, so the body recognizes them as foreign. Over time, however, most tumors can recognize their own immune system through various fire mechanisms and begin to grow uncontrollably. The immunotherapist or inhibitor of immune checkpoints in certain grips works by "releasing the brake" of our immune system, which again recognizes tumor cells as foreign and begins to fight them. While classical chemotherapy works on all cells that divide quickly, and does not differentiate between sick and healthy, with immunotherapists we stimulate our own immune system to recognize sick - cancer - cells. "

Most patients tolerate such treatment more easily than chemotherapy, that most side effects are mild to moderate, most often not threatening to the patient and most often manifest as thyroid dysfunction, various skin rashes, diarrhea pa Serious or life-threatening complications are possible. which can potentially affect any organ system. Here, the key is quick identification of possible complications and referral to a selected oncologist. Recognizing immune-related side effects of immunotherapy is not easy for oncologists either, as they often have similar symptoms and signs as other diseases, so we must rule out other diseases or causes before starting treatment for the complication. "

It is not a miracle cure Immunotherapy is not a miracle cure. "It is not yet clear who will actually benefit and who will not. A study in stage III patients in whom the disease did not progress after radiation and chemotherapy treatment confirmed the benefit of durvalumab immunotherapy both in the prolonged time to disease progression and overall survival. Until then, some patients with stage three lung cancer could still be cured "alone" with chemotherapy and radiation (15 to 25 percent five-year survival). Let's hope that immunotherapy will be able to further improve the survival of these patients. "

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